Abstract Text: Postpartum hemorrhage (PPH) is a common postpartum complication that affects almost 6% of deliveries worldwide. The most common cause is uterine atony of various etiologies (near 90% of cases). Here we present a patient with atonic uterus associated hemorrhage possibly secondary to an IgE-mediated autoimmune dysregulation of connective tissue. A 20 year old female presented with PPH after vaginal delivery which was unresponsive to conservative hemostatic measures. An emergency hysterectomy was performed, and during the procedure, an extremely distended uterus was discovered. Postoperatively we interviewed the patient to find a possible etiology of her complication. The patient revealed prior history of scoliosis, atopic dermatitis, and PEP(polymorphic eruption of pregnancy). Her history was also notable for an autoimmune condition that was in the process of being officially diagnosed prior to her current pregnancy. Her mentioned manifestations are all IgE-mediated processes and are thus reminiscent of an incomplete Hyper-IgE immunoglobulinemia syndrome (HEIS). Current literature linking gestation and immune signaling support this suspicion because most of pregnancy is characterized by Th2-dominant signaling. This signaling is mediated by cytokines IL-4 and IL-13, both of which are also signals for IgE-class switching. IgE has been linked to destruction of certain types of collagen that is also prevalent in the uterus. The relationship between autoimmunity and pregnancy outcomes is a fledgling field of research. This complex relationship between immune response and postpartum complications deserves further study and may indicate more extensive screening for immune dysregulation in pregnant patients to possibly decrease intra and postpartum complications.
